Longitudinal multiple case study on effectiveness of network-based dementia care towards more integration, quality of care, and collaboration in primary care

Abstract

IntroductionThis study aimed to provide insight into the merits of DementiaNet, a network-based primary care innovation for community-dwelling dementia patients.MethodsLongitudinal mixed methods multiple case study including 13 networks of primary care professionals as cases. Data collection comprised continuously-kept logs; yearly network maturity score (range 0–24), yearly quality of care assessment (quality indicators, 0–100), and in-depth interviews.ResultsNetworks consisted of median nine professionals (range 5–22) covering medical, care and welfare disciplines. Their follow-up was 1–2 years. Average yearly increase was 2.03 (95%-CI:1.20–2.96) on network maturity and 8.45 (95%-CI:2.80–14.69) on quality indicator score. High primary care practice involvement and strong leadership proved essential in the transition towards more mature networks with better quality of care.DiscussionProgress towards more mature networks favored quality of care improvements. DementiaNet appeared to be effective to realize transition towards network-based care, enhance multidisciplinary collaboration, and improve quality of dementia care.

Different Contexts, Similar Challenges. SUSTAIN’s Experiences with Improving Integrated Care in Europe

“…The integration of health and social care is a complex process that is (as also outlined under lesson 1) dependent on a plethora of factors. [17][18][19][20][21]. In SUSTAIN, we therefore used participatory implementation research to support local stakeholders to improve their existing ways of working.…”

Clinical leadership and integrated primary care: A systematic literature review

“…Evaluation of complex educational leadership interventions and the complex integrated primary care setting may ask for innovative research designs instead of classical randomized controlled trials. An example of such an innovative design is the longitudinal mixed methods case study to evaluate DementiaNet, an implementation programme for networked primary dementia care [49]. This design enabled a better understanding of the effects and working mechanisms.…”

Development and pilot testing of quality improvement indicators for integrated primary dementia care

“…With DementiaNet, we address needs of professionals (increase knowledge, skills and collaboration); PWD and informal caregivers (personalised care, integration of care and welfare, care coordination and continuity of care); and the healthcare system (local level, tailor-made, system approach, cost-effectiveness and sustainable approach). Full description can be found in the paper of Nieuwboer et al, 14 and the first quantitative evaluation of effectiveness is described by Richters et al 21 methodology is particularly useful to reach agreement on content validity and feasibility; inclusion of a large number of participants prevents domination during the consensus process. 24 25 In four rounds, we (1) developed a preliminary QI set, (2) sent out a survey to stakeholders, (3) discussed results during a stakeholder consensus meeting and (4) discussed results during an expert consensus meeting.…”

“…16 Several QI sets have been developed to assess quality of primary dementia care, including a set of six QIs used to assess DementiaNet networks' quality of care. [17][18][19][20][21] However, these sets do not sufficiently adopt the interprofessional context. Furthermore, existing integrated QI sets do not include well-being issues, 22 or their large number of indicators limits feasibility.…”